动态监测SAA给予抗生素在电子支气管镜联合普米克令舒治疗重症肺炎中的价值研究

Value of antibiotic administration based on dynamic monitoring of SAA in treatment of severe pneumonia by electronic bronchoscopy combined with pulmicort

目的探讨动态监测血清淀粉样蛋白A(serum amyloid A,SAA)给予抗生素在电子支气管镜联合普米克令舒治疗重症肺炎的价值研究。方法选取惠州市中心人民医院2020年1月~2021年1月收治的60例重症肺炎患儿,按照治疗方法的不同将其分为对照组、观察1组、观察2组,分别给予普米克令舒雾化吸入联合抗生素治疗;普米克令舒雾化吸入、电子支气管镜及抗生素治疗;普米克令舒雾化吸入、电子支气管镜及根据SAA监测情况给予抗生素治疗。对比三组临床疗效,观察统计血气指标及不良反应发生率,酶联免疫吸附法测定IL-6、PCT水平,胶体金免疫层分析法测定SAA水平,免疫比浊法检测CRP水平。结果治疗后,患儿PaO_(2)/FiO_(2)、SaO_(2)、PaO_(2)、FVC、PEF、FEV_(1)水平升高,且观察2组PaO_(2)/FiO_(2)、SaO_(2)、PaO_(2)、FVC、PEF、FEV_(1)水平高于对照组、观察1组,具有统计学差异(P<0.05);治疗后,患儿随着时间推移观察1组、观察2组SAA水平降低,且观察2组SAA水平低于对照组、观察1组,具有统计学差异(P<0.05);治疗后,患儿CRP、IL-6、PCT水平降低,且观察2组CRP、IL-6、PCT水平低于对照组、观察1组,具有统计学差异(P<0.05);治疗后,患儿肺部湿啰音、咳喘、住院时间缩短,且观察2组肺部湿啰音消失、咳嗽、住院时间短于对照组和观察1组,具有统计学意义(P<0.05);治疗后,观察2组总有效率(95.00%)明显高于对照组(60.00%)、观察1组(85.00%),具有统计学差异(P<0.05)。治疗后,观察1组不良反应总发生率(30.00%)高于对照组(10.00%)、观察2组(20.00%),无统计学差异(P<0.05)。结论动态监测SAA给予抗生素在电子支气管镜联合普米克令舒治疗重症肺炎具有抗炎功效,改善血气状态,缩短治疗疗程及住院时间,动态监测SAA水平可反映感染严重程度及预后情况,使患儿临床症状及指征显著缓解,肺功能得到显著改善。

Objective To investigate the value of antibiotic administration based on dynamic monitoring of serum amyloid A(SAA)in the treatment of severe pneumonia by electronic bronchoscopy combined with pulmicort.Methods A total of 60 children with severe pneumonia who were treated at our hospital from January 2020 to January 2021 were selected and divided into three groups according to the treatment method used,and were given pulmicort aerosol inhalation plus antibiotic treatment(control group),pulmicort aerosol inhalation plus electronic bronchoscopy plus conventional antibiotic treatment(observation group 1),and pulmicort aerosol inhalation plus electronic bronchoscopy plus antibiotic treatment based on SAA monitoring(observation group 1).The clinical efficacy of the three groups was compared,blood gas indexes and the incidence of adverse reactions were observed and counted,IL-6 and PCT were determined by enzyme-linked immunosorbent assay,SAA level was determined by colloidal gold immunochromatographic assay,and CRP level was detected by immunoturbidimetry.Results After treatment,the levels of PaO_(2)/FiO_(2),SaO_(2),PaO_(2),FVC,PEF,and FEV_(1)were significantly increased,and the levels of PaO_(2)/FiO_(2),SaO_(2),PaO_(2),FVC,PEF,and FEV_(1)in the observation group 2 were significantly higher than those in the control group and the observation group 1(P<0.05).After treatment,SAA level in the observation group 1 and observation group 2 decreased over time,and SAA level in the observation group 2 was significantly lower than that in the control group and observation group 1(P<0.05).The levels of CRP,IL-6,and PCT in children after treatment decreased,and the levels of CRP,IL-6,and PCT in the observation group 2 were significantly lower than those in the control group and observation group 1(P<0.05).The time to disappearance of lung wet rales and cough,and the duration of hospital stay were shortened after treatment,and these indexes in group 2 were signficantly shorter than those in the control group and observation group 1(P<0.05).The total effective rate in the observation group 2(95.00%)was significantly higher than those of the control group(60.00%)and observation group 1(85.00%)(P<0.05).The total incidence of adverse reactions in the observation group 1(30.00%)was higher than that in the control group(10.00%)and observation group 2(20.00%),but there was no statistical difference(P>0.05).Conclusion Antibiotic administration based on dynamic monitoring of SAA has anti-inflammatory effects,improves blood gas condition,and shortens the treatment duration and hospitalization time in the treatment of severe pneumonia by electronic bronchoscopy combined with pulmicort.Dynamic monitoring of SAA level can assess the severity and prognosis of infection,which can help relieve the clinical symptoms and improve the lung function significantly.